Clostridioides Difficile Infection | Antibiotic Stewardship Program | UC Davis Health

What's unique?

We screen all eligible adult patients upon admission for Clostridioides difficile (formerly Clostridium difficile, also known as C. diff) with a rectal swab PCR test. This test looks for C. diff capable of producing toxin. It identifies colonization, not disease. Colonized patients are at greater risk for disease and transmission.

Things to know…

• A positive screening test should not be used for diagnosis and does not require a follow up diagnostic test in the absence of symptoms consistent with C. diff infection (CDI) 
• Colonized patients will be placed on "Contact Enteric" precautions for the duration of their hospital stay
• In the absence of CDI, colonized patients do not need to continue isolation precautions upon discharge or transfer to another facility
• Hand washing with soap and water is necessary for both colonized and infected patients to further reduce transmission

What's the same?

Everything else.

• Diagnostic testing with the "stool toxin EIA" is diagnostic in patients with signs and symptoms compatible with CDI. False positives are still possible, however, if:
  • < 3 watery BMs/day – on stool softeners – on tube feeds – other causes of diarrhea present
• Given increases in community-onset C. diff infection (CO-CDI) without traditional risk factors consider early diagnostic testing in those admitted complaining of diarrhea even if at low to moderate risk
• There is no utility in tests for cure or repeat testing if < 7 days from last negative test
• Most cases of CDI can be treated with: Vancomycin 125 mg PO q6h x 10 days.
• Further guidance for recurrent or severe disease available in the 2018 IDSA guidelines (PDF)